| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE ITASCA, IL 60143 | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | $16K | — | $16K | 0.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | ATTN MARTIN KOOPER 770 LEXINGTON AVENUE #14 NEW YORK, NY 10065 | BLUE CROSS BLUE SHIELD OF TENNESSEE INC | $40K | — | $40K | 4.96% |
| RICHARD K. HOLMES3 Filed as: RICHARD K HOLMES | 414 MEADOWBROOK LANE BIRMINGHAM, AL 35213 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $20K | $2K | $22K | 17.51% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | 1166 AVENUE OF THE AMERICAS 22ND FLOOR NEW YORK, NY 10036 | NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA | $734 | — | $734 | 24.99% |
| RICHARD K. HOLMES3 Filed as: RICHARD K HOLMES | 414 MEADOWBROOK LANE BIRMINGHAM, AL 35223 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $529 | $33 | $562 | 21.26% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 1,213 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 31 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF GEORGIA | 404 | $2.6M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF TENNESSEE INC | 232 | $811K |
| Vision | BLUE CROSS BLUE SHIELD OF TENNESSEE INC | 232 | $811K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 1,225 | $509K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 317 | $124K |
| Long-term disability(3 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 1,225 | $630K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF RHODE ISLAND | 0 | $0 |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE INSURANCE COMPANY | 1,225 | $512K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,225 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.